Hypertension and heart failure with preserved ejection fraction. A past, present, and future relationship.

Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent syndrome with high cardiovascular and non-cardiovascular morbidity and mortality. Hypertension (HT) is one of its major risk factors and participates in its origin, development, and prognosis. The guidelines do not set out specific treatments, as clinical trials show limitations. Hypertension control is fundamental in the prevention and treatment of HFpEF. The guidelines recommend renin-angiotensin system blockade as the mainstay of hypertension treatment in patients with HFpEF. Spironolactone and angiotensin receptor-neprilysin inhibitors are also recommended in some cases. There are also new treatments that are already indicated, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, and promising treatments such as finerenone. A phenotypic classification that allows for more targeted treatments and studies that cover pending issues are yet to be undertaken.

Hypertension and heart failure with preserved ejection fraction. A past, present, and future relationship

Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent syndrome with high cardiovascular and non-cardiovascular morbidity and mortality. Hypertension (HT) is one of its major risk factors and participates in its origin, development, and prognosis. The guidelines do not set out specific treatments, as clinical trials show limitations. Hypertension control is fundamental in the prevention and treatment of HFpEF. The guidelines recommend renin–angiotensin system blockade as the mainstay of hypertension treatment in patients with HFpEF. Spironolactone and angiotensin receptor-neprilysin inhibitors are also recommended in some cases. There are also new treatments that are already indicated, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, and promising treatments such as finerenone. A phenotypic classification that allows for more targeted treatments and studies that cover pending issues are yet to be undertaken.(AU)

La insuficiencia cardiaca con fracción de eyección preservada (ICFEp) es un síndrome de prevalencia creciente con una gran morbilidad y mortalidad, tanto cardiovascular como por otras causas. La hipertensión arterial (HTA) es uno de sus principales factores de riesgo e interviene en su origen, desarrollo y pronóstico. Las guías no establecen tratamientos específicos, ya que los ensayos clínicos muestran limitaciones. El control de la presión arterial es fundamental en la prevención y tratamiento de la ICFEp. Las guías recomiendan el bloqueo del sistema renina-angiotensina como eje del tratamiento de la HTA en pacientes con ICFEp. Asimismo, se recomienda espironolactona y antagonistas del receptor de angiotensina e inhibidor de neprilisina en algunos casos. Existen además novedades ya indicadas, como los inhibidores del cotransportador-2 de sodio-glucosa (SGLT2), y prometedoras como la finerenona. Queda pendiente el desarrollo de una clasificación fenotípica que permita tratamientos más dirigidos y estudios que respondan a aspectos pendientes.(AU)

[Transthoracic and transesophageal echo Doppler in the detection of mitral prosthesis dysfunction due to insufficiency]. / Eco Doppler transtorácico y transesofágico en la detección de disfunción de prótesis mitral por insuficiencia.

UNLABELLED: Severe mitral regurgitation is accompanied by increment of left atrial pressure. The objective of this work was to compare Doppler parameters related to transvalvular peak-pressure gradient in patients with normally functioning and patients with malfunctioning mitral prosthetic valve, secondary to insufficiency, in order to analyze if the presence of high protodiastolic pressure gradient and normal prosthetic valve area could correlate with severe mitral regurgitation (MR). Fourty-two patients were studied. Group I: twenty-two normally functioning prosthesis (15 mechanical, 7 biological). Group II: twenty malfunctioning mitral prosthetic valves secondary to severe insufficiency (11 mechanical and 9 biological), 12 patients with acute MR and 8 with chronic MR. All of the patients were evaluated though transthoracic (TTE) and transesophageal (TEE) Doppler-echocardiography. Diastolic peak velocity prosthetic flow (DVP), protodiastolic gradient (PDG), mean gradient (MG) and prosthetic area (PA) by pressure halftime (PHT) were measured. DVP in Group I was 1.56 +/- 0.29 m/s and 2.49 +/- 0.30 m/s in Group II (p = 0.001). PGD measured 10.36 +/- 3.79 mmHg in Group I and 15.95 +/- 7.48 mmHg in Group II (p = 0.001). MG 4.86 +/- 1.90 mmHg in Group I and 10.38 +/- 4.8 mmHg in Group II (p = 0.001). PA was 2.01 +/- 0.54 cm2 in Group I and 2.10 +/- 0.43 cm2 in Group II (NS). PHT was 115.59 +/- 31.99 mseg in Group I and 108.3 +/- 19.1 mseg in Group II (NS). CONCLUSION: In patients with high PDG (greater than 20 mmHg) and normal prosthetic mitral area assessed by TTE could be suspicious of malfunctioning prosthesis secondary to severe insufficiency. Due to the higher sensitivity and specificity in the diagnosis of malfunctioning mitral prosthesis and the ability to determine the magnitude and severity of prosthetic regurgitation assessment should be completed with TTE.